Automatic feed medical screwdriver

ABSTRACT

A fastener placement system for placement of screws into bone structure during a medical procedure comprises a power driven screw driver, a fastener carrier system with a series of fasteners temporarily attached thereto and an elongated band structure carried by the fastener carrier system for positioning and advancing the individual fasteners of the series of medical fasteners in a controlled manner to a position to receive a driving tip on the powered screw driver. The head of the fastener and the tip of the screw driver have complementary structures which allow the screw head to be simultaneously grasped by the driver tip and the fastener to be driven in a rotary manner for placement into the bone structure.

This is a Continuation of U.S. patent application Ser. No. 11/492,536,filed Jul. 24, 2006.

The present invention is generally directed to a fastener and drivesystem comprising a driving tool and fasteners fed from a cartridgeremoveably attached to the driving tool including a feed system toposition the fastener adjacent the active driving portion of the drivesystem. More specifically, the fastener and drive system is designed forplacing screw fasteners into bones during a medical procedure andparticularly for the placement of very small fasteners in cranialmaxillo-facial procedures and reconstruction of bone supportedanatomical features.

BACKGROUND

Surgical reconstruction of hard tissue, such as the placement ofprosthetics, the repositioning and attachment of fractured bones and theaddition of metallic support plates to repaired bone typically requirethe placement of fasteners, which may be adhesives, mechanical devices,or combinations thereof. In many instances the fastening system includesscrews, which may have special thread and head designs adapted for theparticular application or the placement system. These screws are oftenvery small in size and therefore difficult to handle, position andthread into the underlying structure and can easily be dropped into thesurgical cavity if they are being manually manipulated.

Systems comprise manual screw drivers or, more recently, cordless,battery powered drivers, to transmit a rotational driving force toscrews, which may have specialized heads to match the driver tips.Because a typical procedure may require placement of numerous screws(20-60) the powered drivers are now preferred. A typical power driver isa reusable pencil grip instrument with a replaceable, single use,sterile, disposable battery pack. However, hospital personnel must stillperform the tedious task of attaching each screw to the tip of thescrewdriver or into a retaining structure on the tip and then handing itto the surgeon or manually loading a feeding system adapted to place thescrew in front of the driver tip. The screw head has a recessedstructure, such as a slot or a recessed geometric structure for example,cruciform, Phillips, square, hexagonal or exalobe shaped holes, fortorque transmission from a matching structure on the tip of the driver.For torque transmission and to limit the tip from disengaging from thestructure in the screw head the tolerances of the fit between the tipand the screw head construction are minimal and in some instancestapered to provide secure engagement (U.S. Pat. No. 4,269,246 to Larsonet al.)

There are numerous publications and patents which show devices thatrelate to the field of the invention. They are directed to the placementof, or automatic delivery of, fasteners to a particular location andsystems for driving the fasteners. The following are merelyrepresentative of the art; there are others which are primarilyrepetitive of those discussed herein. Many are for industrialapplications and can not meet the needs of a surgeon for use in anenclosed, sterile environment and do not lend themselves to automaticone hand operation. Systems for delivering a fastener to the operative,rotating tip of a screw driver include:

a) Non-Banded Delivery—U.S. Pat. No. 3,946,926 to Willis is an exampleof a pneumatic or strictly mechanical delivery of fasteners from ahopper. U.S. Pat. No. 4,408,877 to Lindmo et al. appears to cover loosescrews fed along a track disposed in front of the screwdriver tip.

b) Stacked Fasteners—U.S. Pat. No. 5,590,574 to Lide is an example of asystem that provides a linear arrangement of fasteners stacked head totail inside the screwdriver.

c) Vertical Band—There are numerous patents to systems in which thefastener (nail or screw) lies across the face of a band and are attachedto the band by notches or loops extending from the surface of the band.Alternatively the band may have a thickness so that the fastener can beinserted in a hole which extends through the band from one edge to aparallel opposite edge, for example, U.S. Pat. Nos. 5,758,768,5,622,024, 5,469,767, and 4,930,630 to Habermehl as well as numerousother Habermehl patents. However, they all appear to use a band whichattaches to the side of the fastener and which places the band in aplane coextensive with the axis of the screwdriver.

d) Horizontal Band—There are numerous patents that are directed tosystems in which the screw is placed through a hole in the surface ofthe band with the band resting somewhere along the length of the shankof the screw or just below the head of the screw. These include U.S.patents to Chen (U.S. Pat. No. 5,522,687), Dohi (U.S. Pat. No.5,544,746), Hon (U.S. Pat. No. 5,509,768), Huang (U.S. Pat. Nos.5,931,298, 5,803,691, 5,788,445, 5,779,420), Lejdegard (U.S. Pat. No.4,018,334), Lin (U.S. Pat. No. 5,775,514), and Shinjo (U.S. Pat. Nos.5,984,096 and 6,761,268) all of which show various band designs whichinclude extensions created from or formed below the surface of the banddesigned to grip the shaft of the screw.

Other patents are directed to the surgical fasteners and the design ofthe head of the fastener and drivers constructed to work with thesefasteners or hold the fastener during the placement procedure. None ofthese patents include automatic delivery of the fasteners.

These prior devices do not provide the ease of operation and the abilityto continuously and rapidly place numerous screws into the bonestructure while minimizing the risk of loss of the screws during theprocedure and the amount of time necessary to prepare the tool and thefasteners for use in the surgical procedure.

SUMMARY

A fastener, automatic delivery system for the fastener and a drivesystem, preferably powered by replaceable or rechargeable batterieswhich provide automated and continuous delivery and placement of thefasteners from a reloadable cartridge is shown.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective side view of a first embodiment of a fastenerplacement system incorporating features of the invention.

FIG. 2 is a side view of the screw delivery portion of the a fastenerplacement system of FIG. 1

FIG. 3 is a perspective view of the lower side of the embodiment of FIG.2 showing the fasteners in a carrying strip.

FIG. 4 is a perspective cutaway side view of the embodiment of FIG. 2with screw fasteners placed in a band.

FIG. 5 is a side view of a first embodiment of a screw fastener for usein the fastener placement system.

FIG. 6 is a cross sectional view of the screw of FIG. 5 taken along line6-6 of FIG. 5.

FIG. 6 a is an enlarge view of the circled portion of FIG. 6.

FIG. 7 is a top view of the screw of FIG. 5 showing a first embodimentof structure in the screw head to receive a matching driver tip.

FIG. 8 is a side view of a driver tip designed to interact with thescrew head embodiment of FIG. 7.

FIG. 9 is an end view of the driver tip of FIG. 8.

FIG. 10 is a top perspective view of the screw of FIG. 5 mounted in afirst embodiment of a screw feeding band.

FIG. 11 is a bottom perspective view of the band of FIG. 10.

FIGS. 12-12 d show several embodiments of screw retaining configurationsas part of holes in a screw feeding band.

FIGS. 13 a and 13 b, 14 a and 14 b, 15 a and 15 b, and 16 a and 16 bshow several additional embodiments of screw head constructions whichprovide structure within the screw head for grasping the fastener.

FIGS. 17 a, b and c, 18 a, b and c, 19 a, b and c, 20 a, b and c, and 21a, b and c are top, longitudinal cross sections and side viewsrespectively of five embodiments of different hole structure in the headof the fastener as well as an external taper for external grasping ofthe fastener.

FIG. 22 is a perspective side view of a driver tip holding one of theembodiments of FIGS. 17-21.

FIGS. 23 a and b, 24 a and b, 25 a and b, and 26 a and b are top andcross-sectional views respectively of further embodiments of thefastener including extensions from the head of the fastener in place ofholes in the head.

FIG. 27 is a bottom perspective side view of the screw delivery portionshowing the track for mounting the replaceable cartridge assembly.

FIG. 28 is a top perspective view of the screw delivery portion showingthe tape receiving rack with the advancement trigger removed.

FIG. 29 is a longitudinal cross section view of the drive portion of thefastener placement system of FIG. 1.

FIG. 30 is a cutaway side view of the driver tip inserted into the headof the fastener of FIG. 5.

FIG. 31 is a perspective view of an alternative band structure forholding the fasteners.

DETAILED DESCRIPTION

The fastener and driver disclosed herein, referred to in combination asa fastener system, is primarily intended for use in medical procedureswhich require the placement of small surgical screws, such as would beused in a cranial maxillo-facial procedures, prosthetic or an orthopedicprocedure, which are automatically positioned and held in front of thetip of the screwdriver so that multiple screws can be placed in a serialmanner by a one hand operation.

The fastener system includes an automatic finger activated driver havinga tip which rotates around its central, longitudinal axis by anelectrical drive means, such as rechargeable or replaceable batteries.While less preferred, the driver may alternatively be driven by externalAC or DC power sources, or pneumatic or hydraulic drives. As a stillfurther alternative gas cylinders inserted in the driver handle insteadof batteries can be used to provide a replaceable or rechargeable drivesystem. As a still further alternative, the rotating tip can be drivenby a negative pressure provided by an external vacuum source.

A feature of the system described herein is a fastener head constructionand a driver tip configuration which allows the driver tip to beinserted into a depression in the head of the fastener or grasp theouter edge of the head, while at the same time separating the fastenerfrom a carrier strip. This eliminates the task of manually mounting thefastener on the driver tip. The fastener can then be readily transportedto the surgical placement site without fear of dropping the fastener anddriven into the bone at the surgical placement site. The driver tip isthen retracted, leaving the fastener in place in the bone and asubsequent fastener automatically moves into position in front of thedriver tip to repeat the procedure.

A preferred embodiment uses a replaceable cartridge which includes anelongated band with multiple fasteners inserted centrally along thelength of the band. The fasteners are held in the band by structureintegral with the edges of holes in the band, the structure gripping theedge of the head of the fastener. However, other band structures ordifferent retaining structures can be used to hold and place thefasteners in front of the driver tip. Still further, different means,such as a hopper containing fasteners can be used to funnel individualfasteners, one at a time, to a point in front of the driver tip wherethey are temporarily held until the driver tip locks into or onto thefastener head.

One skilled in the art, based on the disclosure set forth herein, candesign other techniques to carry the fastener to a point in front of thedriver tip for placement of the tip in the fastener head ready fordriving into the surgical site.

In a first embodiment multiple screws are temporarily attached along thelength of a band. The screw delivery system includes a removable andreplaceable cartridge structure to enclose the band of screws and atrack for the band of screws to travel along for placement in front of ascrew driver tip. Each successive screw on the band is seriallypositioned in front of the tip of the screw driver tip. A triggermechanism causes the band to move forward in front of the tip, placingthe fastener in the right position to be engaged by the driver tip. Thedriver tip includes an enlarged portion which is inserted into the headof the screw or around the head of the screw so that when the screw isseparated from the band the screw is retained on the tip by interlockingstructures. Moving the tip forward engages the screw head, separates thescrew head from the band, inserts pins on the tip or other geometricshapes into or around matching shapes in the fastener head, and providesrotary motion to the screw so that it can be driven into a targetsurface. This is accomplished by rotating the tip within the driverwhile the screw driver handle is held fixed (not rotated).

A perspective side view of a first embodiment of a fastener placementsystem 10, comprising a screw delivery portion 12 and a driver assembly14 is shown in FIG. 1. The screw delivery portion 12, as best shown inFIGS. 2-4, comprises a cylindrical shell 16 (shown in FIGS. 13 and 14)which has a central, longitudinal opening 18 designed to receive andretain the driver assembly 14. A removable cartridge 20 carryingfasteners 22 is attached to a receiving track 21 on the lower surface ofthe cylindrical shell 16. The cartridge walls are preferably transparentso the user can see the quantity of fasteners remaining in thecartridge. The removable cartridge 20 is preloaded with a moveable strip26 which carries the fasteners 22. Upon assembly for use the moveablestrip 26 is extended from the removable cartridge 20 along the frontportion 28 of the cylindrical shell 16, across the tip 30 of the shell16 and rearwardly across the upper region of the front portion 28 whereit is moveably connected to a trigger 32.

As shown in FIGS. 3 and 4, the fasteners 22 are temporarily andremoveably attached to the elongated band or strip 26 such as shown inFIG. 10. The strip extends rearwardly beyond the last fastener 22 toprovide a tail 23 for extending into the cartridge 20. A leading end 24of the strip 26 extends forward from the front most fastener so that thestrip 26 can be engaged with the under side of the trigger 32. In apreferred embodiment at least 10 fasteners 22 are attached and evenlyspaced along the central portion of the strip 26. The attachment must besuch that the fasteners 22 will remain in position on the strip 26through assembly, packaging and transportation of the removablecartridge 20, installation of the cartridge 20 onto the cylindricalshell 16 and placement of the loaded strip across the tip 30 as well asmovement across the front portion 28 of the cylindrical shell 16. Theattachment must also be sufficient so that the driver tip 34 can engagewith the head 36 of the fastener as the driver tip 34 is advancedforward. However, the temporary connection between the fastener 22 andthe moveable strip 26 must also be readily disrupted thereafter by thefurther forward movement of the driver tip 34, the fastener 22 nowtemporarily and removeably carried by the driver tip 34. Typically, thefastener 22 is held in the strip 26 by a friction fit and/or horizontalor vertical extensions from the edge of mounting holes 38 .Alternatively, a biocompatible glue or adhesive (not shown) could beused to temporarily secure the fastener 22 to the band 26.

A particular embodiment illustrated in the drawings includes a hole 38in the band with two lobes 40 extending outward from the edge of theband 26 partly across the opening of the hole 38 and two tabs 42extending into the hole and downward from the surface. FIG. 11 is abottom perspective view of a portion of the band or moveable strip 26showing the tabs 42. Examples of alternative designs are shown in FIG.12 a-12 d where a row of snowflake shaped openings are shown stamped orchemically etched into the band 26. In FIG. 12 b one of the holes 38 isshown in its initial form (circled portion I) while another hole 38(circled portions II of FIG. 12 b demonstrates the bent down tabs 42with inward extending lobes 40. FIG. 11 c shows the embodiment of FIGS.10 and 11. FIG. 12 a shows an example of leaf spring structures 44 cutfrom the edge of the hole 38. The leaf spring structures 44 have aportion attached to the edge of the hole and one or two ends extendingacross the opening of the hole 38 to provide a spring-like grip againstthe side of the head 36 of the fastener 22. One skilled in the art willrecognize that numerous different structures can be provided to grip thehead 36 of the fastener 22.

Referring back to FIGS. 4, the tail 23 on the band 26, with fasteners 22attached to the band, extends into the cartridge 20 and through atensioning means 46 within the cartridge. Alternatively, the tail 23 canbe attached to a reel or spool which includes a tensioning spring (notshown). The band then passes over first and second guide rollers 48, 50and behind guiding pins 52 which extend from the inner wall 54 of thecartridge 20 over the edge of the strip 26, but not far enough tocontact the fasteners 20. The forward-most fastener 22 is positioned infront of the cylinder tip 30 and the leading end 24 of the strip 26 ispassed under and is engaged with the trigger 32 so that when the trigger32 retracts during use the band is moved forward placing the nextavailable fastener 22 in position on the cylinder tip 30.

FIG. 1 is a perspective side view and FIG. 29 is a longitudinalcross-sectional view of an embodiment of the fastener placement system10 showing the driver assembly 14 within the screw delivery portion 12.Included within the screw delivery portion 12 is a power source,preferably a rechargeable or replaceable battery 56 which drives a motor57, gear box 107 and drive transmission coupling 207 which in turnprovides rotary motion to the driver tip 34. The motor 57 and gearassembly can include a reversing means so the tip can be rotated toinsert or remove the fastener from the target bone surface. Alsoincluded are means for operatively connecting the trigger 32 on thecylinder 16 so that moving the trigger forward (toward the tip 34) alsomoves the driver tip 34 forward. When the trigger 32 is released aspring mechanism 58 causes the driver tip 34 to retract and, at the sametime advance the strip 26, positioning the next fastener 22 for use. Aseparate spring (not shown) causes the pin 68 to retract.

FIGS. 5-7 show a preferred embodiment of the fastener 22 for use withthe fastener placement system 10. The threaded portion 60 is similar tothat on threaded fasteners currently used for medical applications. Thehead 36 of the fastener 22 has a recessed surface 62 which includes tworadially spaced holes 64 extending perpendicular to the recessed surface62. These holes are sized to receive two like-sized and shaped driverpins 68 which extend from and retract into the driver tip 34. While thedriver pins 68 are preferably sized and shaped like the holes, they canbe of any shape as long as they fit in the holes. Also, the holes 64 donot have to be round but can be of any shape and in fact can each be adifferent shape. The wall of the head 36 of the fastener 22 extendingabove the recessed surface 62 has a taper 66 extending inwardly from thetop down, as best shown in FIG. 6a. FIGS. 8 and 9 show a similar shapedoutwardly extending portion or flange 70 on the driver tip 34. Theflange 70, being slightly larger then the top of the taper 66, allowsthe driver tip 34 to be inserted into the head of the fastener 22 andgrasp the fastener head 36, interlocking with the head 36 of thefastener 22, as shown in FIG. 30 to separate the fastener from the strip26.

To use the fastener placement system 10 a loaded cartridge 20 is slidinto track 21 on the lower wall of the cylindrical shell 16, themoveable strip 26 is placed over the front portion 28 and across the tip30. A first fastener 22 is positioned extending outward from the tip 30.The leading edge 24 is fed under the trigger 32. The trigger 32 ismanually advanced toward the tip 30, which causes power from the battery56 to be delivered to the motor 57, causing the tip 34 to rotate and tomove forward toward the fastener head 36. Continued forward movementcauses the flange 70 to enter the head of the fastener and interlockwith the taper 66 while at the same time the driver pins 68 are extendedinto the holes 64 in the head of the fastener 22. Substantiallysimultaneously with the flange 70 and taper 66 grasping each other andthe pins 68 entering the holes 64 the fastener 22 becomes detached fromthe strip 26. The driver tip 34, with the rotating fastener 22 attachedthereto, now extends through the mounting hole 38 and the rotatingfastener 22 can be applied to the bone surface for securing the bonepieces together. Releasing the trigger 32 allows spring 58 to exertrearward motion on the driver tip 34. The separate springs (not shown)also cause the pins 68 to retract, the driver tip 34 to separate fromthe fastener head 36 and the rotation of the driver tip 34 to cease. Asthe trigger moves back to its resting position extensions on the bottomof the trigger (not shown) set into drive holes 72 spaced along the edgeof the band 26, grasping the band and causing the leading edge 24 tomove rearward, which positions the next fastener 22 in front of thecylinder tip 30 and driver tip 34 so that the above described action canbe repeated.

While the above described embodiment describes two pins 68 that insertinto holes 64 in the fastener head 36 one or more geometric shaped holesor slots in the head of the fastener 22, and matching structure on thedriver tip 34 can be used to accomplish the same screw placementfunction. Alternative interacting hole or holes 64 and driver tip 34include numerous common structures used on the head of screws and boltsincluding but not limited to Phillips head, Allen wrench, slots andother geometric shapes as shown in FIGS. 12-21 a. FIGS. 13-16 show somealternative designs for the fastener head structure. While FIG. 7 showsa circular top inner edge on the recess, other non-circular or modifiedcircular designs may be used. FIGS. 13-16 a and b are top andcross-sectional views of four alternatives. FIGS. 16 a and b show afastener 34 with a round, serrated edge 67 to aid in grasping thefastener for rotation. FIG. 13 a and b show an upper inner edge with sixsides, but other geometric shapes can be used. FIGS. 14 and 15 showrounded variations of the design of FIG. 13.

FIGS. 17-21 a, b and c show top, cross sectional and side views of fivealternative embodiments with different shaped hole 64 structures in thehead 36 of the fastener 22. As best shown in FIGS. 17-21 c, thesefasteners 22 also have a taper 66 on the outer surface of the head 32which can be grabbed by inwardly extending portion 74 on a driver tip 34as shown in FIG. 22. FIGS. 23-26 a and b are top and longitudinalcut-away views of still further embodiments which show extensions 76from the head 36 of the fastener. The driver pins 68, instead of sittinginto holes 64 in the head 36 of the fastener 22 are structured to graspor surround the extensions 76. One skilled in the art will recognizethat a combination of holes 64 and extensions 76 can also be used.

FIG. 31 shows an alternative band 126 which has an upper band 128, whichholds the fastener 22 in a manner as described above, and a lower band130 to aid in aligning the fastener. The lower band 130 also has holesthere through which have a diameter greater than the head 36 of thefastener 22 so the fastener will pass through without bending. Alsoshown is the driver tip (with the cylindrical shell 16 not shown). Theupper band 128 and lower band 130 are connected by posts 132. To allowthe two layer band to wrap around curves, the lower band 130 has slits134 across the width.

1. A device for automatically feeding a series of medical fasteners to alocation for mating with a rotary fastener driver and for placement ofeach of said series of medical fasteners into tissue or bone structureto hold said tissue or bone structure together, comprising: a driverbody, a powered screw driver positioned within the driver body, afastener carrier system removable from and attachable to the driver bodyand means for positioning and advancing the individual fasteners of theseries of medical fasteners in a controlled manner to a position toreceive a driving tip on the powered screw driver, the medical fastenercomprising a screw having a head with a recess therein for receiving thetip of the screw driver, the head of the screw and the tip of the screwdriver having interlocking structures such that, once the tip isinserted in the recess in the screw head the screw is carried by thedriver tip until intentionally dislodged, the recess further includingone or more structures therein or thereon which interact with matingstructures on the driver tip to transmit rotary motion of the driver tipto the screw.
 2. The device of claim 1 wherein the fastener carriersystem comprises an elongated band, the band having a leading end, atrailing end and central fastener retaining portion, the centralfastener retaining portion having holes equally spaced along the lengththereof on a central longitudinal axis, a fastener located in each ofsaid holes and held in the hole by contacting means extending from theedges of the hole inwardly and in contact with the outer surface of theside wall of the head of the fastener.
 3. The device of claim 2 whereinthe contacting means comprise one or more lobes extending from the inneredge of the hole parallel to the upper surface of the band, one or morespring-like extensions attached to the inner edge of the hole, or one ormore tabs extending from the inner edge of the hole substantiallyperpendicular to the upper surface of the band.
 4. The device of claim 1wherein the recess in the screw head has a depth suitable to receive thetip of the screw driver, an inner side wall extending from an upper edgeof the recess to a lower edge of the recess, at least a portion of theinner side wall having a peripheral length greater then the length ofthe periphery of the upper edge, the tip of the screw driver having anenlargement thereon, the tip configured so that the enlargement can bepushed into the recess in the screw head and lodge within said portionof the inner wall.
 5. The device of claim 4 wherein the portion of theinner side wall tapers outwardly from the upper edge of the recess. 6.The device of claim 4 wherein the side wall of the recess has a uniformcontour along its entire circumference.
 7. The device of claim 1 whereinthe one or more structures therein or thereon which interact with matingstructures on the driver tip to transmit rotary motion of the driver tipto the screw comprises one or more holes in the base of the recess forreceiving one or more like shaped structures or pins on, extending orextendable from the screw driver tip.
 8. The device of claim 7 whereinthe one or more holes comprise one or more star shaped indents, one ormore slots, or one or more geometric shapes in the base of the recess.9. The device of claim 1 wherein the means for positioning and advancingthe individual fasteners of the series of medical fasteners in acontrolled manner to a position to receive a driving tip on the poweredscrew driver comprises a trigger mounted on the driver body, a) movementof said trigger to a driving position extends the tip of the screwdriver to interlock said tip with the head of the fastener, removes thefastener from the fastener carrier system and causes rotary motion to beapplied to the fastener for driving the fastener into the bonestructure, and b) release of the trigger or movement of the trigger toan off position following positioning of the fastener in the bonedisconnects the screw driver tip from the fastener head, retracts thescrew driver tip from the fastener carrier system and causes thefastener carrier system to advance forward, to position a subsequentfastener in a position to be grasped by the screw driver tip.
 10. Adevice for feeding a series of medical fasteners to a location formating with a rotary fastener driver and for placement of each of saidseries of medical fasteners into tissue or bone structure to hold saidtissue or bone structure together, comprising: an assembly including apowered screw driver and a fastener carrier mounted external thereto,the fastener carrier including, or adapted to receive, a series ofindividual medical fasteners on a moveable band to provide and positionsaid individual fasteners of the series of medical fasteners in acontrolled manner to a position to receive a driving tip on the poweredscrew driver, the medical fastener comprising a screw having a head withsecuring structure therein or thereon interacting with the tip of thescrew driver such that, once the tip is placed in contact with the screwhead the screw is carried by the driver tip until intentionallydislodged, the head further including one or more driving structurestherein or thereon which interact with mating structures on the drivertip to transmit rotary motion of the driver tip to the screw.
 11. Thedevice of claim 10 wherein the moveable band comprises an elongated bandhaving a leading end, a trailing end and central fastener retainingportion, the central fastener retaining portion having holes equallyspaced along the length thereof on a central longitudinal axis, afastener located in each of said holes and held in the hole bycontacting means extending from the edges of the hole inwardly and incontact with the outer surface of a side wall of the head of thefastener.
 12. The device of claim 11 wherein the contacting meanscomprise one or more first extensions extending from the inner edge ofthe hole parallel to the upper surface of the band and one or moresecond extensions attached to the inner edge of the hole extending in adirection other then parallel to the upper surface.
 13. The device ofclaim 12 wherein the one or more second extensions from the inner edgeof the hole are substantially perpendicular to the upper surface of theband.
 14. The device of claim 10 wherein the screw head has a recesstherein with a depth suitable to receive the tip of the screw driver, aninner side wall extending from an upper edge of the recess to a loweredge of the recess, at least a portion of the inner side wall having aperipheral length greater then the length of the periphery of the upperedge, the tip of the screw driver having an enlargement thereon, the tipconfigured so that the enlargement can be pushed into the recess in thescrew head and lodge within said portion of the inner wall.
 15. Thedevice of claim 14 wherein the portion of the inner side wall tapersoutwardly from the upper edge of the recess.
 16. The device of claim 10wherein the driving structure therein or thereon which interacts withmating structures on the driver tip to transmit rotary motion of thedriver tip to the screw comprises a side wall shape on the screw head,one or more holes in the base of a recess in the screw head forreceiving one or more complementary shaped structures or pins on,extending or extendable from the screw driver tip or one or moreextensions from the head of the fastener to be received by complementarystructure on the screw driver tip.
 17. The device of claim 16 whereinthe one or more structures comprise one or more star shaped indents orextensions, one or more slots or elongated extensions, or one or moreholes or extension with a defined shaped periphery in or on the head ofthe fastener, the screw driver having a complementary structure fordriving the head of the screw in a rotary manner.
 18. The device ofclaim 10 wherein the screw head has structure on the outer surfacethereof to receive or be received by complementary structure on thedriver tip, the tip of the screw driver having an enlargement thereon orindent therein so that the enlargement thereon or indent therein can bepushed over the screw head and lodge and grasp the outer wall of thehead of the screw.
 19. The device of claim 10 further including atrigger mechanism which interacts with the moveable band to place afastener in a position to be grasped by the driving tip, activation ofthe trigger causes rotary motion to be applied to the fastener toseparate the fastener from the band and drive the fastener into thebone.
 20. An assembly for placing or removing a fastener from a bonecomprising a powered screw driver and individual medical fasteners, thedriver having a configuration designed to interact with the head of thefastener such that the head of the fastener is grasped by the drivertip, the medical fastener comprising a screw having a head with securingstructure therein or thereon interacting with the tip of the screwdriver such that, once the tip is placed in contact with the screw head,the screw is carried by the driver tip until intentionally dislodged,the head further including one or more driving structures therein orthereon which interact with mating structures on the driver tip, saidmating structures on the driver tip transmitting rotary motion of thedriver tip to the screw.
 21. The device of claim 20 wherein the screwhead has a recess therein with a depth suitable to receive the tip ofthe screw driver, an inner side wall extending from an upper edge of therecess to a lower edge of the recess, at least a portion of the innerside wall having a peripheral length greater then the length of theperiphery of the upper edge, the tip of the screw driver having anenlargement thereon, the tip configured so that the enlargement can bepushed into the recess in the screw head and lodge within said portionof the inner wall.
 22. The device of claim 21 wherein the portion of theinner side wall tapers outwardly from the upper edge of the recess. 23.The device of claim 20 wherein the driving structure therein or thereonwhich interacts with mating structures on the driver tip to transmitrotary motion of the driver tip to the screw comprises a side wall shapeon the head of the screw, one or more holes in a base of a recess in thehead for receiving one or more complementary shaped structures or pinson, extending or extendable from the screw driver tip or one or moreextensions from the head of the fastener to be received by complementarystructure on the screw driver tip.
 24. The device of claim 23 whereinthe one or more structures comprise one or more star shaped indents orextensions, one or more slots or elongated extensions, or one or moreholes or extension with a defined shaped periphery in or on the head ofthe fastener, the screw driver having a complementary structure fordriving the head of the screw in a rotary manner.
 25. The device ofclaim 20 wherein the screw head has structure on the outer surfacethereof to receive or be received by complementary structure on thedriver tip, the tip of the screw driver having an enlargement thereon orindent therein so that the enlargement thereon or indent therein can bepushed over the screw head and lodge and grasp the outer wall of thehead of the screw.